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This work was supported by the Mayfield Education and Research Foundation to Dr Hartings and the Hungarian Scientific Research Fund (Grant No. K111923 to Farkas), the Bolyai János Research Scholarship of the Hungarian Academy of Sciences (BO/00327/14/5) to Dr Farkas, and the National Institutes of Health (NS083858) to Dr Kirov. Dr Sahuquillo is a recipient of a grant from the Fondo de Investigación Sanitaria (Instituto de Salud Carlos III) (FIS PI08/0480) cofinanced by the European Regional Development Fund (ERDF). This work was also supported by the Toyota Foundation to Drs Fabricius and Friberg. Dr Boutelle is supported by Wellcome Trust/UK Dept of Health under the HICF Scheme (WT094912/HICF-1010-080).\nMegjegyzés-26656994\nN1 Funding details: DFG DR 323/6-1, DFG, Deutsche Forschungsgemeinschaft\nN1 Funding details: NS083858, NIH, National Institutes of Health\nN1 Funding details: WT094912/HICF-1010-080, ERDF, European Regional Development Fund\nN1 Funding text: This work was supported by Deutsche Forschungsgemeinschaft (DFG DR 323/6-1), the Bundesministerium für Bildung und Forschung (Center for Stroke Research Berlin, 01 EO 0801; BCCN 01GQ1001C B2), and Era-Net Neuron 01EW1212 to Dr Dreier, NeuroCure SESAH (EXC 257/2) to Drs Dreier and Heinemann, and DFG DR 323/5-1 to Drs Dreier, Woitzik, Vajkoczy, Sakowitz, Graf, Vatter, and Friedman. This work was supported by the Mayfield Education and Research Foundation to Dr Hartings and the Hungarian Scientific Research Fund (Grant No. K111923 to Farkas), the Bolyai János Research Scholarship of the Hungarian Academy of Sciences (BO/00327/14/5) to Dr Farkas, and the National Institutes of Health (NS083858) to Dr Kirov. Dr Sahuquillo is a recipient of a grant from the Fondo de Investigación Sanitaria (Instituto de Salud Carlos III) (FIS PI08/0480) cofinanced by the European Regional Development Fund (ERDF). This work was also supported by the Toyota Foundation to Drs Fabricius and Friberg. Dr Boutelle is supported by Wellcome Trust/UK Dept of Health under the HICF Scheme (WT094912/HICF-1010-080).\nMegjegyzés-26657007\nN1 Funding details: DFG DR 323/6-1, DFG, Deutsche Forschungsgemeinschaft\nN1 Funding details: NS083858, NIH, National Institutes of Health\nN1 Funding details: WT094912/HICF-1010-080, ERDF, European Regional Development Fund\nN1 Funding text: This work was supported by Deutsche Forschungsgemeinschaft (DFG DR 323/6-1), the Bundesministerium für Bildung und Forschung (Center for Stroke Research Berlin, 01 EO 0801; BCCN 01GQ1001C B2), and Era-Net Neuron 01EW1212 to Dr Dreier, NeuroCure SESAH (EXC 257/2) to Drs Dreier and Heinemann, and DFG DR 323/5-1 to Drs Dreier, Woitzik, Vajkoczy, Sakowitz, Graf, Vatter, and Friedman. This work was supported by the Mayfield Education and Research Foundation to Dr Hartings and the Hungarian Scientific Research Fund (Grant No. K111923 to Farkas), the Bolyai János Research Scholarship of the Hungarian Academy of Sciences (BO/00327/14/5) to Dr Farkas, and the National Institutes of Health (NS083858) to Dr Kirov. Dr Sahuquillo is a recipient of a grant from the Fondo de Investigación Sanitaria (Instituto de Salud Carlos III) (FIS PI08/0480) cofinanced by the European Regional Development Fund (ERDF). This work was also supported by the Toyota Foundation to Drs Fabricius and Friberg. Dr Boutelle is supported by Wellcome Trust/UK Dept of Health under the HICF Scheme (WT094912/HICF-1010-080).\nCenter for Stroke Research Berlin, Charité University Medicine Berlin, Charité Campus Mitte, Charitéplatz 1, Berlin, 10117, Germany \n Department of Neurology, Charité University Medicine Berlin, Berlin, Germany \n Department of Experimental Neurology, Charité University Medicine Berlin, Berlin, Germany \n Department of Clinical Neurophysiology, Rigshospitalet, Copenhagen, Denmark \n Neurovascular Research Laboratory, Department of Radiology, and Stroke Service and Neuroscience Intensive Care Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States \n Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States \n Department of Neurosurgery, Klinikum Ludwigsburg, Ludwigsburg, Germany \n Department of Neurosurgery, University Hospital, Heidelberg, Germany \n Department of Neurosciences, University of New Mexico School of Medicine, Albuquerque, NM, United States \n Department of Neurology, University of Cologne, Cologne, Germany \n Multimodal Imaging of Brain Metabolism, Max-Planck-Institute for Metabolism Research, Cologne, Germany \n Department of Neurosurgery, Charité University Medicine Berlin, Berlin, Germany \n Department of Neurology, Neurocritical Care Unit, Medical University Innsbruck, Innsbruck, Austria \n Department of Neurosurgery, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan \n Department of Neurology and Rehabilitation Medicine, Neurocritical Care Division, University of Cincinnati College of Medicine, Cincinnati, OH, United States \n Department of Neurosurgery, Antwerp University Hospital and University of Antwerp, Edegem, Belgium \n Department of Neurology, Rigshospitalet, Copenhagen, Denmark \n Department of Neurosurgery, University Hospital and University of Bonn, Bonn, Germany \n Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom \n Inserm U10128, CNRS UMR5292, Lyon Neuroscience Research Center, Team TIGER, Lyon, France \n Université Claude Bernard, Lyon, France \n Department of Neurosurgery, Goethe-University, Frankfurt, Germany \n Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH, United States \n Neuroscience Research Center, Charité University Medicine Berlin, Berlin, Germany \n Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany \n Neurological Center, Segeberger Kliniken, Bad Segeberg, Germany \n Department of Clinical Physiology and Nuclear Medicine, Rigshospitalet, Copenhagen, Denmark \n Research Laboratory for Stereology and Neuroscience, Bispebjerg-Frederiksberg Hospital, Rigshospitalet, Copenhagen, Denmark \n Department of Neuroradiology, Charité University Medicine Berlin, Berlin, Germany \n Faculty of Health and Medical Sciences, Panum Institute, University of Copenhagen, Copenhagen, Denmark \n Neurocritical Care, Columbia University College of Physicians and Surgeons, New York, NY, United States \n Department of Neurosurgery, University of New Mexico School of Medicine, Albuquerque, NM, United States \n Department of Physiology and Cell Biology, Zlotowski Center for Neuroscience, Beer-Sheva, Israel \n Department of Neuroradiology, Soroka University Medical Center and Zlotowski Center for Neuroscience, Ben-Gurion University of the Negev, Beer-Sheva, Israel \n Department of Medical Neuroscience, Faculty of Medicine, Dalhousie University, Halifax, Canada \n Department of Neurosurgery, University of Cologne, Cologne, Germany \n Department of Neurosurgery and Brain and Behavior Discovery Institute, Medical College of Georgia, Augusta, GA, United States \n Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Canada \n Department of Medical Physics and Informatics, Faculty of Medicine, and Faculty of Science and Informatics, University of Szeged, Szeged, Hungary \n Department of Neurology, University of Utah, Salt Lake City, UT, United States \n AniRA-Neurochem Technological Platform, Lyon, France \n Department of Neurosurgery, Neurotraumatology and Neurosurgery Research Unit (UNINN), Universitat Autònoma de Barcelona, Barcelona, Spain \n Department of Physics, Humboldt University, Berlin, Germany \n Institute of Physiology I/Neurophysiology, Friedrich Schiller University Jena, Jena, Germany \n Department of Systems Neuroscience, Cajal Institute-CSIC, Madrid, Spain \n Department of Bioengineering, Imperial College London, London, United Kingdom \n Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA, United States \n Department of Neurological Surgery, University of Miami, Miami, FL, United States \n Hans Berger Department of Neurology, Jena University Hospital, Friedrich Schiller University Jena, Jena, Germany \n Institute for Clinical Epidemiology and Applied Biometry, University of Tübingen, Tübingen, Germany \n Department of Human Genetics, Leiden University Medical Center, Leiden, Netherlands \n Department of Neurology, Leiden University Medical Center, Leiden, Netherlands \n Center for Image Sciences, University Medical Center Utrecht, Utrecht, Netherlands \n Department of Critical Care Medicine and Neurology, University of Pittsburgh Medical Center, Pittsburgh, PA, United States \n Mayfield Clinic, Cincinnati, OH, United States \n Department of Spinal Surgery, St. Franziskus Hospital Cologne, Cologne, Germany \n Department of Psychiatry, University of British Columbia, Vancouver, Canada \n Lannister-Finn Corporation, Bryn Mawr, PA, United States \n Department of Neuroscience and Pharmacology, Panum Institute, University of Copenhagen, Copenhagen, Denmark \n Cited By :90 \n Export Date: 8 June 2020 \n CODEN: JCBMD \n Correspondence Address: Dreier, J.P.; Center for Stroke Research Berlin, Charité University Medicine Berlin, Charité Campus Mitte, Charitéplatz 1, Germany; email: jens.dreier@charite.de \n Funding details: Deutsche Forschungsgemeinschaft, DFG, DR 323/6-1 \n Funding details: Toyota Foundation \n Funding details: National Institutes of Health, NIH, NS083858 \n Funding details: WT094912/HICF-1010-080 \n Funding details: Hungarian Scientific Research Fund, OTKA, K111923 \n Funding details: Magyar Tudományos Akadémia, MTA, BO/00327/14/5 \n Funding details: Deutsche Forschungsgemeinschaft, DFG \n Funding details: Bundesministerium für Bildung und Frauen, BMBF, 01EW1212, BCCN 01GQ1001C B2, EXC 257/2, DR 323/5-1, 01 EO 0801 \n Funding details: European Regional Development Fund, FEDER \n Funding details: Instituto de Salud Carlos III, ISCIII, FIS PI08/0480 \n Funding text 1: This work was supported by Deutsche Forschungsgemeinschaft (DFG DR 323/6-1), the Bundesministerium f?r Bildung und Forschung (Center for Stroke Research Berlin, 01 EO 0801; BCCN 01GQ1001C B2), and Era-Net Neuron 01EW1212 to Dr Dreier, NeuroCure SESAH (EXC 257/2) to Drs Dreier and Heinemann, and DFG DR 323/5-1 to Drs Dreier, Woitzik, Vajkoczy, Sakowitz, Graf, Vatter, and Friedman. This work was supported by the Mayfield Education and Research Foundation to Dr Hartings and the Hungarian Scientific Research Fund (Grant No. K111923 to Farkas), the Bolyai J?nos Research Scholarship of the Hungarian Academy of Sciences (BO/00327/14/5) to Dr Farkas, and the National Institutes of Health (NS083858) to Dr Kirov. Dr Sahuquillo is a recipient of a grant from the Fondo de Investigaci?n Sanitaria (Instituto de Salud Carlos III) (FIS PI08/0480) cofinanced by the European Regional Development Fund (ERDF). This work was also supported by the Toyota Foundation to Drs Fabricius and Friberg. 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Spreading depolarizations are increasingly recorded during multimodal neuromonitoring in neurocritical care as a causal biomarker providing a diagnostic summary measure of metabolic failure and excitotoxic injury. Focal ischemia causes spreading depolarization within minutes. Further spreading depolarizations arise for hours to days due to energy supply-demand mismatch in viable tissue. Spreading depolarizations exacerbate neuronal injury through prolonged ionic breakdown and spreading depolarization-related hypoperfusion (spreading ischemia). Local duration of the depolarization indicates local tissue energy status and risk of injury. Regional electrocorticographic monitoring affords even remote detection of injury because spreading depolarizations propagate widely from ischemic or metabolically stressed zones; characteristic patterns, including temporal clusters of spreading depolarizations and persistent depression of spontaneous cortical activity, can be recognized and quantified. Here, we describe the experimental basis for interpreting these patterns and illustrate their translation to human disease. We further provide consensus recommendations for electrocorticographic methods to record, classify, and score spreading depolarizations and associated spreading depressions. 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